• 作者： 陳幸鴻; 劉湘梅
• 作者服務機構： 國立成功大學醫院外科學科; 國立成功大學醫學院病理學科
• 中文摘要： 神經斷離後，最理想之手術修補方法為將兩斷端重新吻合。但有時這種損傷太過廣泛嚴重，此時會因斷端間隔太大而不得不求助於神經移植片的應用。最近幾年，在動物實驗當中，利用人工合成的管子以修補神經已獲致令人滿意的結果。先前我們已經證實在非通透性之矽管內填充以纖維蛋白凝塊可加速神經再生，本次實驗我們將嘗試由自體膠原及洋菜糖來製造神經移植片並評估其實用性。我們將老鼠兩側之坐骨神經截斷，然後在右側以填滿自體纖維蛋白凝塊之聚合膠原管來修補截斷的神經；左邊則以矽管取代膠原管為神經移植片。一、二和四個月後，將兩側再生之神經取出，進行顯微鏡及神經形態數量分析。我們證實兩種管子都能支持神經再生，穿越神經間隙而順利長入遠側。 膠原管會引起一緩慢的異物反應，有巨噬細胞及異物巨細胞的侵潤。但此反應兩個月後就開始減弱了。四個月後，新生的神經為一外膜所包被而與膠原管壁間隔以一層分泌液。在矽管中段之新生有鞘軸突數目為9117±282，而膠原管中為8589±137。我們初步的研究工作顯示此生物合成之膠原管對於周邊神經的修復深具臨床應用潛力。
• 英文摘要： Following extensive or multiple nerve injury, repair by nerve graft is the treatment of choice. Inrecent years, nerve repair using tubes made of synthetic material has yielded satisfactory results in experi-mental animals. Previously we have demonstrated that fibrin clot formed within an impermeable siliconetube promoted nerve regeneration. In the present study, we evaluated the applicability of a nerve graftfabricated out of autologous collagen and agarose. The copolymer collagen tube, 1 cm long and filled withautologous fibrin clot was implanted between transected rat right sciatic nerve and the left sciatic nerve wassimilarly transected and repaired with silicone tube. After 1,2, and 4 months the regenerated nerves wereremoved and processed for light microscopic and morphometric analysis. We demonstrated that both typesof tubes supported extensive nerve regeneration across the gap to reach the distal segment. The collagentubes provoked a slow foreign body response with infilitration by macrophages and foreign body giantcells which became abated after 2 months. After 4 months, the nerve regenerate was encapsulated andseparated from the collagen tube by a fluid exudate. The number of myelinated axons at midpoint in thenerve regenerate in the silicone tube was 9117±282 while that in the collagen tube was 8589±137. Thispreliminary study has demonstrated that collagen polymer tube may have potential use in peripheral nerverepair.
• 中文關鍵字： nerve graft; collagen; nerve regeneration; biomaterial.
• 英文關鍵字： --